Treatment with TPA
Introduction:
Stroke - also referred to as "brain attack" - is the third leading cause of death in the United States after heart disease and cancer. It is the leading cause of serious long term adult disability in the U.S.
In the past, the main treatment of stroke is prevention. After stroke the main treatment is supportive care, minimize complications and prepare patient for stroke rehabilitation.
ActivaseŽ (Tissue Plasminogen Activator), better known as TPA has been used for treatment of acute heart attack for several years now. Its benefit in reducing the damage from heart attack is clearly established.
It has now clearly shown that TPA can help to reduce the long term disability from a stroke as well.
Stroke is slightly more complicated than a heart attack for several reasons:
- Symptoms of stroke are not as easily identified as a heart attack. Awareness of stroke
being an medical emergency is very low.
- Brain tissue is more sensitive to lack of blood flow than the heart. Permanent damage to
brain tissue occurs more rapidly than heart muscle when blood supply is compromised.
- Bleeding into the brain from weakened blood vessel is a major concern when TPA is used.
Unlike heart muscle, brain tissue does not contract and is more prone to have bleeding.
- For TPA to work for stroke, patient needs to receive the medication within 3 hours after the symptoms begin. After 3 hours, TPA is not only ineffective, but may be dangerous. There are also many different conditions that TPA cannot be given due to increased risks of complications.
Quick questions to establish whether patient has a stroke
- Did this start all of a sudden?
- Stroke came on all of a sudden It may get worse after it started
- If a neuro problem came on gradually, it is usually not a stroke
- Was the patient normal before this happen?
- Was patient talking, walking, eating, driving well
- If the patient has trouble walking, talking, driving in the past few weeks, it may not be a stroke.
Importance of establishing time of onset of stroke
It is very important to establish the time of onset of stroke. If the time of onset cannot be reasonably established, patient is not a candidate for TPA.
Questions for patient/family about symptom onset time
- Last time patient felt completely normal ?
- What was the patient doing ?
- What were you (family member) doing ?
- How do you know the time ?
